不同状态肾功能与冠心病发病率及冠状动脉病变严重程度的分析

摘要

目的 探讨不同程度肾功能降低患者的冠心病发病率及其冠状动脉病变的严重程度.方法 收集9608例行诊断性冠状动脉造影疑诊冠心病的患者进行回顾性分析,依据适合中国人的改良MDRD方程估算的肾小球滤过率(eGFR)水平将患者分为肾功能正常(＞90 ml·min-1·1.73 m-2)、轻度降低(60 ～89 ml·min-1·1.73 m-2)、中度降低(30～59 ml·min-1·1.73 m-2)和重度降低(＜29 ml· min-1·1.73 m-2)4组,探讨不同程度肾功能损害患者的冠心病发病率及其冠状动脉狭窄的严重程度.结果 9608例患者中存在肾功能降低(eGFR＜ 90 ml· min-1·1.73 m-2)者4939例,占51.4％.肾功能降低组患者冠心病发病率显著高于肾功能正常组(55.7％比44.3％,P＜0.001),且冠状动脉狭窄程度更为严重,表现为患者病变支数更多(1.38±1.13比1.06±1.08,P＜0.001)、Gensini积分更高(29.36±35.53比21.32±30.30,P＜0.001).肾功能正常组与轻度、中度、重度降低组患者冠心病的发病率分别为59.7％、69.4％、79.1％、92.3％,冠心病发病率随肾功能降低的程度而明显增高(P＜0.001).线性回归分析显示:Gensini积分与慢性肾病(Chronic kidney disease,CKD)分期(β=0.061,OR值3.219,95％CI:2.075～4.364,P＜0.001)呈独立正相关.Logistic回归分析证实:CKD与冠心病诊断存在显著关联(OR值1.330,95％ CI:1.177～1.503,P＜0.001).结论 肾功能降低患者的冠心病发病率明显升高,且其冠状动脉狭窄程度更为严重；患者肾功能降低越显著,则冠心病发病率越高；肾功能降低与冠状动脉狭窄程度呈独立正相关；CKD与冠心病发生存在显著关联.%Objective The aim of this study was to determine the relationship between renal insufficiency and severity of coronary artery disease ( CAD) in a large cohort of catheterized patients. Methods 9608 consecutive patients underwent coronary angiography were selected. All patients were stratified into four estimated glomerular filtration rate(eGFR) groups base on the revised MDRD equation for Chinese population: normal (eGFR > 90ml ? Min-1 ?1. 73 m -2), mild reduction (60-89 ml ? Min -1 ? 1. 73 m-2 ), moderate reduction (30-59 ml ?min-1 -1. 73 m-2), and severe reduction (eGFR <29 ml ?min"1 ? 1. 73 m ). We observed the impact of renal insufficiency on the development of CAD and the severity of atherosclerotic process. Results There were 4939 (51.4%) renal insufficiency (eGFR <90m?min-1 ? 1.73 m-2) patients among all 9608 patients. The incidence of CAD was higher in the renal insufficient group than in the other group (55. 7% vs. 44. 3% , P < 0. 001). Furthermore, the average number of stenotic coronary arteries was higher (1. 38 ± 1. 13 vs. 1. 06 ± 1. 08, P < 0. 001), as well as Gensini score was higher (29. 36 ±35. 53 vs. 21. 32 ±30. 30, P <0. 001). The incidence of CAD in the four groups were 59. 7% , 69.4% , 79. 1% , 92. 3% respectively, which showed that the incidence of CAD were associatedwith the renal insufficiency ( P < 0.001 ) . Linear regression analysis showed that Gensini score was independent positively correlated with CKD stage (β = 0.061, OR = 3. 219, 95% Cl: 2.075 -4. 364, P < 0.001). Binary logistic regression analysis showed that CKD was associated with CAD (OR = 1. 330, 95% CI: 1. 177 - 1. 503, P <0. 001). Conclusions The incidence of CAD was higher in the renal insufficiency group, and with more severe coronary artery stenosis. The incidence of CAD were associated with the degree of renal insufficiency. Renal insufficiency has independent positive correlation with coronary artery stenosis and CKD was associated with CAD.